There's only one romantic relationship, in part 6, and it involves a human side character and the disembodied head of a large animated statue. This is intentionally kind of weird, but both parties are presented as adults, so any age difference probably doesn't matter.
[Culture Shock] Features a psychiatrist's office and a mental institution for former child stars, though the game lacks the usual imagery. (The former is a repurposed tattoo parlor, while the latter is an abandoned theatre.)
In part 6, a character is so nervous about an upcoming date that he throws up. (This is necessary to solve a puzzle so it can't be avoided, but it's very obvious when it's going to happen.)
No outright drug use, but there are some suggestive jokes. One time there are suggested to be drugs in the gumball machine, and there's a joke about soda pop being addictive in one part.
In part 6, one of the puzzles involves putting back together Max's hand, stomach, and tail after they are removed (by "magic", not cutting). It's not at all gory, it's just a cartoon figure with a couple of detached parts.
In the final chapter of the game, it is a major unavoidable plot point to make multiple characters v*. However, it's incredibly cartoony and the sound effects aren't drastic or extensive. I didn't even have to mute or look away for any of it.
In the "retro" version of the game, Sam and Max make jokes calling Bosco a sissy when he dresses up as his mother, but these jokes have been removed in the remastered version.
[In general] Max is frequently referred to as a psychopath, sociopath, or crazy. [Culture Shock] Features a comically-unqualified Psychiatrist who uses very out-of-date language, only some of which is commented on.
both sam and max carry guns and use them repeatedly, nobody is harmed as they never shoot anybody. this can still be upsetting if you are triggered by guns
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